Prescription Refill Request

Please fill out the following details as thoroughly as you can as it will help us care for your pet and get their prescription filled. If you have any questions or need help filling out this form, please call or text the clinic at 817-523-1139.

Your Name *

First Name Last Name

Your Email

Not required but in order to get a copy of your form, please fill this out! Thanks!

Your Phone Number *

Please enter a valid phone number.

*

To be filled at Summer Creek Animal Clinic To be filled at an outside pharmacy Written prescription to be picked up at Summer Creek Animal Clinic

What is the Name of the Outside Pharmacy? *

Pharmacy Phone Number

Please enter a valid phone number.

Pharmacy Address (If not online)

Street Address

Street Address Line 2

City

Should the outside Pharmacy be reaching out to us? *

Yes, they should reach out to you No, please put in a refill request to this pharmacy

Your Pet's Name *

How many prescriptions are you requesting? *

Name of the Prescription Requested *

Size (mg, weight range, mL, lbs, etc.)

Quantity Requested (number of pills, bottles, boxes, bags, etc.)

Prescription Directions (Ex: 1/2 a tablet, twice a day, 1 cup, twice a day)

Name of the Prescription Requested *

Size (mg, weight range, mL, lbs, etc.)

Quantity Requested (number of pills, bottles, boxes, bags, etc.)

Prescription Directions (Ex: 1/2 a tablet, twice a day, 1 cup, twice a day)

Name of the Prescription Requested *

Size (mg, weight range, mL, lbs, etc.)

Quantity Requested (number of pills, bottles, boxes, bags, etc.)

Prescription Directions (Ex: 1/2 a tablet, twice a day, 1 cup, twice a day)

Name of the Prescription Requested *

Size (mg, weight range, mL, lbs, etc.)

Quantity Requested (number of pills, bottles, boxes, bags, etc.)

Prescription Directions (Ex: 1/2 a tablet, twice a day, 1 cup, twice a day) *

Anything else you would like us to know? We're here to help!

Have your prescription in front of you? Take a photo of the item!

Please read the following details on the turnaround time for specific products! Thank you for your patience as we work tirelessly to get your pet their prescriptions.

We will reach out if we need to schedule your pet for an appointment within 72 business hours after your request as sometimes this is required in order to fill your pet's medications.
If your refill is already approved and no appointment is needed, then the timeline for pick-up will be within 72 business hours after your request for products we carry in clinic. Don't worry, we'll send you a text when it's ready!
Medication that we need to call into an outside pharmacy or special order for you will take time to order and ship, so this can take up to 5 (sometimes more) business days. We will move as quickly as possible to get these for your pet.
For Hill's food that is special ordered, we get our shipments on Friday and will need your order no later than Thursday morning to receive the food that week. Please be aware there are a lot of back-ordered products at this time!
There may be a delay with your prescription due to your pet's veterinarian being out of the office, Holidays, back-ordered products, extended shipping times, or other unforeseen events. We will do our best to communicate these delays to you as quickly as possible. Our number one goal is to care for you and your pet, so let us know if there is anything we can do! Thank you!

- Your Team At Summer Creek Animal Clinic

5228 Sycamore School Road, #100 Fort Worth, TX 76123

Monday-Friday 8:00am to 6:00pm
Saturday, Sunday: CLOSED
Closed for team meetings Fridays 12:00pm to 1:00pm

The expedited fee is new and will start on 8/1/21! Thank you! Until then we will not charge for this service.

Is this an emergency refill? If so, for a small fee ($7.50) we can push this request to the front of the queue and do our best to refill this same day. If this is not accomplished, the expedited fee will not be charged to your refill.

Yes, please expedite my refill No, this is not an emergency and the normal lead time is fine

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